HomeMy WebLinkAboutPermit Electrical 2011-2-25
_El~ctrical Permit A
.
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753+ FAX(S41)726-3689
~~
'DEPARTMENT USE ONLY
(<:5Q2-']..O\\ ~OO
rut no.:
Dale 2-- H~
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This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is Dot started within ]80
days of issuance or if work is suspended for 180 days.
LOCAL. GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
Commercial
vJ.
:PROPERTY OWNER
Name:
\).~
City:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
.CONTRACTOR INSTALLATION'
City:
Phone
E-mail: '
Print name of signing supervisor:
Signature of signing supervisor:
~~~
NOTICE: EXPIRE IF THE \)\IOR~ lj.
THIS PERMIT SH.tILL THIS PERMIT IS NO
.tI\JTHOR\Z~.?o.~~~EI: !\t3~NOONEO_ FO\'
MMENl..;tU V" '- '
CO CD\rn
PlN'< 180 OA'< \,,,,,
440-2584-J(9/08/CCl1l)
. FEE SCHEDULE
Numl)er of inspections per item ( ), Qty, Cost Total
ea, cost
Residential, pel' unit, service included:
1,000 sq, ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2) Sen'ices or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
RecoDlle<:t only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or ATsT(I2)"J IIUN: uregoll ".:::J.VI [ , $ 63.00 $
. .1 ~._ ~_.J I " ~ t. .
201 to 400 1?~(J.: I UI"'~ uuvv......". ~ , .
IT .~tinn r,pntp.r. Th, lSe r ,I $' 87.00 $
40110 600il\T@;i(~ 952-001-001 0 tl rou~ '$126.00 $
'1iI~Q- :6oo'VOi"V '2,pJ"'" ,.,,,,.. ,
Over 600 a . ]. '. olts, see service"s' or fceders section above
. . " _ __~ _ _ ,,, I r ",. " r, "
Iltfel~~ ~I.~""" V.....II'....." \. n p
Branch circ_,ll): a !tf.rq!~~4.5ff5t!.S.!/?r Pe..': panel "c ,1
a. Fee for branch circu8t~i~lP~cQa{e:Qf.lEsei:vice onfeeder fee:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, I $ 63.00 $R.t>l)
alteration, or extension (2)
Eacb additional inspection: (1) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ is. Ot>
(Minimum Permit Fee SS8.00)
(B) Enter 12% surcharge (.12 x [A]) $7.51.
(C) Technology Fee (5% of [A]) $1.1 S
TOTAL fees ancfSurcharges- (A th'rough C): - - $7< . 7(
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541.726-3753
www.ci.springfield.or.us
811-SPR2011-00308
3106 PIERCE PKWY
permilcenter@ci.springfield.or.us
RECEIPT NO: 2011000355 RECORD NO: 811.SPR2011.00308 DATE: 02/25/2011
lDES.CRlltnC)N: ,..,::~.' ~"T,"";",,.;i?JLi.}.~' "c.',7':~,~~", ::..;;~'i:":Acco..UNJLcobE:tk.~:""~:'.:.i';~.MOUNTcDlJE " " ,."
Signal circuit(s) or Ijmited~energy panel, alteration, or extension 224-00000-426102 63.00
State of Oregon SurchargeE2.~:~ of applicable fees) 821.00000.215004 7.56
Technology fee (5% of permit total) 100-00000-425605 3.15
TOTAL DUE: 73.71
,,-, :;"'''.fF:l: AMOUNTPAID') ~~ '. ". . i
~""..--,,,,,~ ' ..c-,..c..,:L.;;;~' _
73.71
trJ~AXME-~f_1Xl~~~~~:~:~.55:QB~~,<cAsiIlER::~~S~A6o~~";; '..,,~: ~c'q~.Mlf.!ISiti:~'-
Check SECURECOM INC
48020
TOTAL PAID:
73.71
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